Provider Demographics
NPI:1588535058
Name:FORD, CRYSTAL (LPC-A)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7415 RIVERCANE SHORE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3066
Mailing Address - Country:US
Mailing Address - Phone:832-907-9773
Mailing Address - Fax:
Practice Address - Street 1:7415 RIVERCANE SHORE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3066
Practice Address - Country:US
Practice Address - Phone:832-907-9773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty